Diabetic gastroparesis refers to cases of the digestive condition gastroparesis due to diabetes. Gastroparesis affects how the stomach moves food into the intestines and can lead to bloating, nausea, and heartburn.
This article provides an overview of diabetic gastroparesis, including its causes, symptoms, complications, and treatments.
During normal digestion, the stomach contracts to help break down food and move it into the small intestine. Gastroparesis disrupts the stomach’s contraction, which can interrupt digestion.
Diabetes can cause gastroparesis due to its effects on the nervous system.
Both type 1 and type 2 diabetes can cause nerve damage. One of the nerves diabetes may damage is the vagus nerve, which controls the movement of food through the stomach.
When the vagus nerve experiences damage, the muscles in the stomach and other parts of the digestive tract are not able to function properly. As a result, food cannot move as quickly through the digestive system.
Doctors also refer to gastroparesis as delayed gastric emptying.
Signs and symptoms of gastroparesis vary in severity from person to person and may include a combination of the following:
Some people with diabetes are at
Risk factors for developing diabetic gastroparesis include:
- having type 1 diabetes
- having type 2 diabetes for longer than 10 years
- having coexisting autoimmune diseases
- having a history of certain gastric surgeries
Additionally, people who have had certain cancer treatments, such as radiation therapy around the chest or stomach area, are more likely to develop gastroparesis.
Gastroparesis makes it harder for a person with diabetes to manage their blood sugar levels.
Sometimes, the stomach of a person with gastroparesis may take a very long time to empty the food into the intestine for absorption. Other times, the stomach may pass the food very quickly.
This unpredictability makes it difficult for someone with diabetes to know when to take insulin, meaning their blood sugar levels may get too high or too low at times.
Blood sugar levels that are too high put a person with diabetes at
- kidney damage
- eye damage, such as retinopathy and cataracts
- heart disease
- foot complications that can lead to amputation when severe
When blood sugar levels drop too low, a person with diabetes may experience the following:
Other complications from diabetic gastroparesis can include:
- bacterial overgrowth in the digestive tract
- indigestible masses, known as bezoars, which can cause stomach obstruction
- electrolyte imbalances
- tears in the esophagus from chronic vomiting
- inflammation of the esophagus that may cause difficulty swallowing
If a healthcare professional suspects a person with diabetes has gastroparesis, they will
Gastric emptying scintigraphy
This test is used to evaluate how quickly the stomach empties. It involves eating food that contains a small amount of a radioactive compound before an imaging test, which generally takes around
A gastric emptying breath test involves eating a meal that contains a substance that is gradually excreted into the breath. A healthcare professional then collects samples of the breath in regular intervals over several hours to measure how quickly the stomach empties.
Wireless motility capsule
With this test, a person swallows a small electronic device known as a SmartPill, which travels through the digestive tract and transmits data to a recorder. The person later passes the capsule naturally through a bowel movement.
A healthcare professional can use the information captured by this capsule to determine the speed of stomach emptying and diagnose diabetic gastroparesis if it is present.
A healthcare professional may also order a barium X-ray to check whether other conditions could be causing symptoms, such as gastric outlet obstruction.
For a barium X-ray, a person will fast for 12 hours, drink a liquid containing barium, and then have an abdominal X-ray. The barium will coat the stomach to make it visible on an X-ray.
Usually, a person who has fasted prior to this test has an empty stomach. However, someone with gastroparesis may still have some food in theirs.
A gastric manometry measures the activity of the muscles in the stomach.
During a gastric manometry, a healthcare professional will insert a narrow tube through a person’s throat into their stomach. The tube includes a device that measures the stomach’s activity as it digests food. The measurements show how well the stomach is functioning.
A medical professional who suspects diabetic gastroparesis may also order any of the following tests:
- Blood tests: Doctors use these to check for nutritional deficiencies and electrolyte imbalances that are common with gastroparesis.
- Imaging: Images of the gallbladder, kidneys, and pancreas can help rule out gallbladder problems, kidney disease, or pancreatitis as causes.
- An upper endoscopy: A doctor can use this test to check for abnormalities in the structure of the stomach.
Managing blood sugar levels is the most important part of treating diabetic gastroparesis.
Most medical professionals will advise a person with the condition to check their blood sugar levels more frequently than someone with diabetes who does not have gastroparesis. More regular blood sugar checks can help the individual and their healthcare team better tailor their treatment to their needs.
- changing the dosage and timing of insulin
- oral medications for gastroparesis, including drugs such as metoclopramide or erythromycin that stimulate the stomach muscles or relieve nausea
- avoiding drugs that may delay gastric emptying, such as opiates
- changes in diet and eating habits
In some cases, a person with diabetic gastroparesis may need a feeding tube or intravenous nutrition. Healthcare professionals only recommend this if the person cannot manage their blood sugar or the gastroparesis is very severe.
When a person needs a feeding tube, it will bypass the stomach completely, putting nutrients directly into the intestine. This helps keep blood sugar levels stable. In many instances, feeding tubes are temporary.
Often, healthcare professionals will
- eating frequent, smaller meals instead of three larger meals each day
- limiting high fiber foods, such as broccoli, which take longer to digest
- sticking to mainly low fat foods
- eating well-cooked vegetables instead of raw vegetables
- avoiding alcohol and carbonated drinks
A healthcare professional may also recommend the person eat certain foods, including:
- lean meats, such as lean cuts of beef or pork
- skinless poultry with a low fat preparation method, avoiding frying
- low fat fish
- tomato sauce
- cooked carrots and mushrooms
- skinless sweet potatoes
- applesauce with no added sugar
- low fat milk or yogurt
Also, a doctor or dietitian will likely recommend a person with diabetic gastroparesis make some changes around meal times, such as taking a walk after eating to promote digestion. Likewise, they may suggest waiting at least 2 hours after eating to lie down.
A comprehensive review of diabetic gastroparesis in the journal
People with diabetic gastroparesis are more likely to experience eye damage, kidney damage, and heart disease than those with diabetes alone. This increased risk of complications may raise a person’s risk of an early death due to diabetes-related causes.
The likelihood of complications and the overall outlook for a person with diabetic gastroparesis will vary between individuals. However, people can generally improve their outlook by learning how best to manage their blood sugar levels each day.
Gastroparesis affects the movement of food from the stomach into the intestines. It can cause symptoms such as nausea, bloating, and heartburn.
Diabetic gastroparesis is gastroparesis that results from a person having diabetes. People with this condition may experience more complications from diabetes than those with diabetes who do not have gastroparesis.
There are several treatment options for the condition. The key aspect is managing blood sugar levels. People can speak with a healthcare professional to learn how best to tailor their diet to improve symptoms and reduce their likelihood of developing complications.
Visit our dedicated diabetes hub for in-depth resources on managing the condition.